Kasim Nader, Khare Swapnil, Sandouk Zahre, Chan Christine
Division of Pediatric Endocrinology and Diabetes, Helen Devos Children's Hospital, Grand Rapids, MI, USA.
Department of Endocrinology, Diabetes and Metabolism, Indiana University, Indianapolis, IN, USA.
J Clin Transl Endocrinol. 2021 Nov 16;26:100275. doi: 10.1016/j.jcte.2021.100275. eCollection 2021 Dec.
Oral glucose tolerance testing (OGTT) is the primary method to screen for and diagnose cystic fibrosis-related diabetes (CFRD). Diagnostic thresholds as currently defined are based on microvascular complications seen in type 2 diabetes. Abnormal glucose tolerance (AGT) refers to OGTT glucose elevations outside the normal range and encompasses both impaired and indeterminate glucose tolerance. Current guidelines define impaired glucose tolerance (IGT) as a 2-hour glucose of 140-199 mg/dL (7.8-11 mmol/L) and indeterminate glucose tolerance (INDET) as any mid-OGTT glucose ≥ 200 mg/dL (11.1 mmol/L) with a normal fasting and 2 h glucose. There is growing evidence that AGT also has associations with CF-centered outcomes including pulmonary decline, hospitalizations, and weight loss. Here we aim to review the historical emergence of glucose tolerance testing, review relevance to risk stratification for CFRD, discuss alternate cutoffs for identifying AGT earlier, and highlight the need for larger, future studies to inform our understanding of the implications of IGT and INDET on CF health.
口服葡萄糖耐量试验（OGTT）是筛查和诊断囊性纤维化相关糖尿病（CFRD）的主要方法。目前定义的诊断阈值基于2型糖尿病中所见的微血管并发症。葡萄糖耐量异常（AGT）是指OGTT血糖升高超出正常范围，包括糖耐量受损和糖耐量不确定。当前指南将糖耐量受损（IGT）定义为2小时血糖为140 - 199 mg/dL（7.8 - 11 mmol/L），将糖耐量不确定（INDET）定义为口服糖耐量试验期间任何血糖≥200 mg/dL（11.1 mmol/L）且空腹血糖和2小时血糖正常。越来越多的证据表明，AGT也与以囊性纤维化为中心的结局相关，包括肺功能下降、住院和体重减轻。在此，我们旨在回顾葡萄糖耐量试验的历史沿革，探讨其与CFRD风险分层的相关性，讨论更早识别AGT的替代临界值，并强调未来需要开展更大规模的研究，以增进我们对IGT和INDET对囊性纤维化健康影响的理解。
